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THE ASSOCIATION
BETWEEN NASOPHARYNGEAL SUCTION AND OXYGEN REQUIREMENT IN BRONCHIOLITIS PATIENTS.
Tami Zemlicka-Dunn
RRT, BS, Julie Ballard, RRT, BS, Quality Care Assessment Team (QCAT) members;
John Salyer, RRT, MBA, FAARC. Respiratory Care Service, Primary Children?s Medical
Center, School of Medicine, University of Utah.
Introduction: We have long believed that nasopharyngeal (NP) suctioning of the hypopharynx
with a catheter is an important part of the care of pediatric bronchiolitis
patients. Indeed this has been our standard of care since 1997. However, many
others use bulb suction or similar non-invasive techniques. We sought to determine
if we could quantify the effect of NP suctioning on the ability to wean these
patients. Our QCAT members regularly assess patients with bronchiolitis. Our
standard of care during assessments includes initially weaning oxygen of patients
if possible based on pulse oximetry. Patients are then suctioned if necessary
and weaned if possible.
Methods: Data
were gathered using retrospective chart review for the period from Oct 2000
to Apr 2001. Inclusion criteria were 1)diagnosis of bronchiolitis, 2) <
24 months of age, 3) non-ICU admission, 4) documentation of floor suctioning
while receiving oxygen. Data included whether suctioning episodes were the 1st,
2nd or 3rd since being admitted to the floor for each
patient, and whether or not suctioning resulted in weaning of the oxygen. Our
standard of care is to wean patients at pulse oximetry levels > 88%.
Results: 421
patients met the inclusion criteria, of which there were a total of 1,141 1st,
2nd or 3rd suctioning interventions. During the study period we had no formal
or informal reports of suctioning related morbidities.
Discussion: It is clear that even after traditional weaning by pulse oximeter, that NP suctioning
in about 1/4 of these patients results in further weaning, even during subsequent
suctioning events. NP suctioning clearly has a positive effect on the need for
oxygen. Some consider NP suctioning controversial in this population. We have
been told it is ?too traumatic?, and ?not effective?. Our findings suggest that
it is effective, and our experience indicates that it is safe. We recommend
the use of NP suctioning in the care of bronchiolitis patients.
OF-01-233
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